Reproductive risks and fertility preservation in women treated with radioactive iodine therapy for thyroid cancer

Radioactive iodine (RAI) therapy is widely used after thyroidectomy in differentiated thyroid cancer. As most of these patients are young women, the potential effects of RAI on reproductive health are of clinical importance. Several studies show menstrual irregularities, transient amenorrhoea and early menopause in women with thyroid cancer. Emerging evidence shows that RAI therapy is associated with a decline in anti-Müllerian hormone levels. As reproductive safety of RAI therapy has not been proven, it is debatable whether proactive fertility preservation should be offered before RAI exposure to safeguard reproductive autonomy. This narrative review summarizes the current evidence on the reproductive risks associated with RAI therapy, and the strengths, weaknesses, opportunities, and threats analysis evaluates the rationale for fertility preservation. The goal is to review benefits versus risks, areas of uncertainty and prospects for future research to support evidence-based counselling and decision-making in women of reproductive age who are candidates for RAI therapy for thyroid cancer.